Better doctor training too. There was an article on it a while back, I'll see if I can dig it up. The way Cuba uses exports of doctors is pretty impressive, as well.

Cuba may lack a bit when it comes to serving it's population, but the humongous difference in Cuba is the quality of PREVENTATIVE medicine; that alone is the real life saver and the thing that keeps the cost of health care down.
Hell Cuba even has a longer life expectancy than the US.
I know some Canadian citizens that went to Cuba for orthopaedic surgery that even North American doctors didn't want to touch, with remarquable results.
The mere fact that Cuba is not as high tech as North America, implies that the Cuban doctors have to pursue a more thourrough questionning of case histories and that their Medical intuition has to be more fine tuned than the North Americans, PET scans, MRI and such advanced tools are not as abundant so the diagnostics skills have to be worked to near perfection. That is a huge difference intraining and contribute to lower the cost of medicine.
Also, in most countries medical cost won't drive you tho bankrupcy and hence patients have less of a tendency to litigate enormous legal suits against their doctors.

Bottom line - the US spends more and has the same or worse metrics for everything except optional surgery waiting times. Canada and the US had similiar per capita health care costs, and Canada's dropped by 1/3rd when it went to single payor healthcare. One could tease out the what happened each decade or every few years (for example, HMO's are what caused the per capita drop in US costs, but that per capita drop ended and increases since then are substantial), but the general trends are very clear.

That's the point of this post - the US spends way more and gets the same or worse care. I am aware of no research that indicates otherwise.

I'm sorry but you haven't given any evidence of such a bottom line.

The US, per your cites, score lower on some OECD metrics. You are missing any step that shows that those metrics measure value received per health-care dollar spent. The questions you don't have time for point out some reasons why your chosen metrics aren't very convincing.

Oh, and, as for studies suggesting that the US does get a good value per dollar spent -- well, such are hard to formulate. The measure of "value/quality of care" here is very far from clear.

-t

(...)

184 United States 6.50
185 Taiwan (Republic of China) 6.40
186 Cuba 6.33
187 Korea, South 6.28
188 Faroe Islands 6.24
189 Italy 5.94
190 Man, Isle of 5.93
191 Aruba 5.89
192 New Zealand 5.85
193 San Marino 5.73
194 Greece 5.53
195 Monaco 5.43
196 Ireland 5.39
197 Jersey 5.24
198 United Kingdom 5.16
199 Gibraltar 5.13
200 European Union 5.10
201 Portugal 5.05
202 Netherlands 5.04
203 Luxembourg 4.81
204 Canada 4.75
205 Guernsey 4.71
206 Liechtenstein 4.70
207 Australia 4.69
208 Belgium 4.68
209 Denmark 4.56
210 Slovenia 4.45
211 Spain 4.42
212 Switzerland 4.39
213 Macau 4.37
214 France 4.26
215 Austria 4.18
216 Andorra 4.05
217 Germany 3.93
218 Czech Republic 3.93
219 Malta 3.89
220 Norway 3.10
221 Finland 3.00
222 Japan 2.80
223 Sweden 2.43
224 Hong Kong 2.40
225 Iceland 2.34
226 Singapore 2.10

Source - Wiki, List of countries by infant mortality rate (2005)

Why, in your estimation, might that be?

An appalling statistic. Personally, my *guess* is that the best way to work on that is to fight poverty directly.

What you aren't establishing, with that statistic, is that there's any evidence *at all* that the infant mortality rate indicates a poor value received per dollar spent on health care. There is no reason to believe, for example, that changing the rules of the US health care system will improve the infant mortality rate, at least in ways that are on-balance positive.

-t

I merely asked a question. I was indeed seeking to establish something, which I believe I did, but it was "meta" rather than substantive.

It would indeed be informative to break out those infant mortality rates and see how they're distributed across the US income curve vs how they're distributed elsewhere. I'd like to see which countries the infant mortality rates amongst American poor compare with as opposed to those who can afford American healthcare.

Sorry for the misunderstanding.

I like your "meta" and by "Yes, and?" I mean... well, yes, and? I.e., keep going. The hard work of politics, and all.

I think your suggestions of what would be informative to look into are good. So? :-)

-t

Wow, you really are reaching, aren't you. I'm going to respond one more time, then I think you go into my personal "ignore for being repeatedly unwilling to deal with facts."

The US has a higher infant mortality rate.

It has less specialists.

It has less doctors per capita

It keeps people less time in acute care beds.

It has about the the same or slightly worse life expectancy.

There are less beds period than most.

Even on surgery, there are countries which give optional care as fast as the US, with universal health care.

Kash has a good summary, you can find it on the left hand side of this blog, and in those pages are graphs and numbers that indicate everything I said above.

http://angrybear.blogspot.com/2005/04/health-care-in-us-and-world-part-iii.html

The US pays substantially more and it gets less or about the same as other OECD companies.

There is no reason to believe that the US gets more by paying more - ever single statistic indicates otherwise.

Your unwillingness to admit what the clear preponderance of the evidence indicates shows that the person who is holding to his ideological position despite the facts, is you. I don't know what axe are grinding here at the Agonist, but I'm getting very tired of your insistence that I and others are here are blinded by ideology when the clear indication, on this and on other issues, is quite the reverse - it is that you will grasp any straw, any technicality, in order to believe what you want to believe no matter what the preponderance of the facts.

I'm beginning to think that those who have told me that you are a troll, and should be treated as one "don't feed the trolls", are correct.

the "rich white guy" health plan, I can say with authority that we do.

And its totally, 100% unfair.

It's similar to American public schools--the best, richest schools are practically the best in the world (and all the rich kids go to them), while all the rest are really bad. When averaged together, our total score comes in a bit on the low side. But if they separated out the data, we'd actually have two systems: One at the head of the first world developed economies and another wallowing somewhere in the middle of the third world. Ok, maybe near the top of the third world... still...

I suspect health care is much the same way, here in the good old US of A.

Still, upper-income white guys in America have worse health than lower-income white guys in Britain.

how our infant mortality rates are not tied to an inadequate health care system? Just a few hypotheticals. Why don't you think infant mortality rates correspond to quality of health care and in what circumstances can there be such a disconnect over many years?

Do you have any sources that measure health care quality that you would like to cite in response to Ian's post? It would help if we knew what you were looking at, since infant mortality, life expectancy, number of hospital beds, $$ spent per capita, etc. are generally taken to be indicators of the quality of health care in a country. Do you have any sources that say otherwise and provide alternative statistics?

I just found this (PDF warning) with a quick google search. Its data is from '98, but it does back up Ian's assertions. What's wrong with this document and others like it?

Sorry for all the questions, but I'm having a hard time understanding just why you seem to think the stats that Ian cites say little to nothing about the quality of US health care. How else would you measure it?

how our infant mortality rates are not tied to an inadequate health care system? Why don't you think infant mortality rates correspond to quality of health care and in what circumstances can there be such a disconnect over many years?

I'm trying to approach those questions very concretely. Suppose we are going to spend $X and/or pass some law and our main goal is to improve public health statistics such as infant mortality rates. Then one question we have to ask is how do we spend that $X or what do we do in that law to have the best return on investment?

I don't claim to have the answer for that but I have some thoughts about how and where to look for the answer.

The CDC reports:

Examples of Important Disparities
Infant mortality among African Americans in 2000 occurred at a rate of 14.1 deaths per 1,000 live births. This is more than twice the national average of 6.9 deaths per 1,000 live births. The leading causes of infant death include congenital abnormalities, pre-term/low birth weight, Sudden Infant Death Syndrome (SIDS), problems related to complications of pregnancy, and respiratory distress syndrome.3 SIDS deaths among American Indian and Alaska Natives is 2.3 times the rate for non-Hispanic white mothers.4

So, right away, we have to suspect that poverty is a major factor. We know that poverty is correlated with poor nutrition, poor education, higher rates of smoking, environmental discrimination, higher levels of violence, higher rates of alcohol abuse and the abuse of illegal drugs, etc.

So, should we spend our dollar or pass our law to, for example, guarantee pre-natal wellness checkups to anyone who wants them? or on attacking poverty? That might sound like a loaded question but it isn't meant to be. Medical care reform is not neutral with respect to its impacts on poverty, and vice versa. It's a genuinely hard question that requires careful study of the entire systems involved.

Do you have any sources that measure health care quality that you would like to cite in response to Ian's post? It would help if we knew what you were looking at, since infant mortality, life expectancy, number of hospital beds, $$ spent per capita, etc. are generally taken to be indicators of the quality of health care in a country. Do you have any sources that say otherwise and provide alternative statistics?

I think it is relatively easy to measure the overall health of a population, and almost impossible to measure the overall quality of a health care system. There are easy measures one can take of a health care system such as doctors per capita, case-load per doctor, and number of acute care beds per capita. How those statistics relate to population health is much harder to judge. For example, are acute care beds more important? or is disaster preparedness more important? They suggest very different spending strategies when building out health care systems.

To measure health care quality -- how effective a system is at actually providing care to people who use it -- I think one needs to do very careful and detailed studies patient histories and outcomes. For reform, one has to relate courses of treatment to outcomes and trace those courses back to the decision making processes that produced them. For example, some studies have argued that there is over-treatment in the US -- e.g., stints are used too often to prevent heart attacks but the outcomes are no better than simpler treatments like aspirin and cholestoral blockers. Some argue that that overtreatment is the result of the customary practice of paying doctors "per procedure" rather than putting them on a steady salary. That kind of analysis makes a lot of sense to me, even though I don't know enough to be sure if, say, stints in particular are over-used. I can't help but note that the private market is beginning to think about that kind of analysis: some private systems are taking a long hard look at the VA's success levels in order to learn to be more effective; more than a few VC's are thinking, these days, about building out infrastructure for electronic medical records (a key ingredient in the VA's success); I've even seen private-practice physicians experimenting with subscription-based fee structures (essentially putting themselves on salary).

I just found this (PDF warning) with a quick google search. Its data is from '98, but it does back up Ian's assertions. What's wrong with this document and others like it?

Yes, I also found and skimmed that report last night. It does also mention the same OECD statistics that Ian did. It talks about injustice and high economic costs of having so many who are uninsured.

It mentions some interesting half-positives, such as:

4) RESPONSIVENESS: Based on WHO's international comparisons, the U.S. was first among the 191 member countries in the category of responsiveness, the extent to which caregivers are responsive to client/patient expectations with regard to non-health areas such as being treated with dignity and respect, etc. However, this figure almost certainly covers over the existence of extreme disparieits in responsiveness among different populations. [In particular and especially the uninsured.]

On the topic of infant mortality, the report you cite has this to say:

These infant mortality figures for the U.S. are somewhat misleading, however, since they obscure the persisting wide disparities among racial groups, based in large part on economic differences. As the U.S. Department of Health and Human Services indicates, the infant mortality rate for black children (14.3 in 1998) is more than twice that of white children (6.0 deaths per 1,000 live births), and it is higher still in some areas of the country. For example, the 1999 infant mortality rate for black children in Alabama was 16.0 infant deaths befoer age one, among 1,000 live births. Many health policy analysts consider such figures a shocking indictment of living conditions for segments of the population in the richest country on earth. [emphasis added]

It is quite a leap to get from something like infant mortality rates to the conclusion that reform of the health care system is the cure.

-t

My son almost died because no doctor was there to monitor what was happening to my wife.

The dollars spent lining the pockets of insurance companies are not dollars well spent. Sending a woman home 24 hours after 26 hours of labor and 3rd level tearing, because the insurance company says to, is poor service and a cause for litigation and more bad dollars spent. BTW the third level tearing was caused because no doctor was available to assess what was happening until 25 hours of labor had passed. Putting a person back in an ambulance and sending him to a different hospital 20 miles away because they don't have insurance coverage at this ER but it turns out he does but oh, too late, he couldn't talk because he was badly injured but not dead yet but then it turns out he didn't have coverage at the other hospital is another sink for bad dollars. Doctors not seeing patients at all because the triage nurse has determined that this person will not die in the next hour and assigning a nurse practitioner to take care of a person with a possible ruptured spleen is another sink for dollars. Leaving a woman in a waiting area who is showing definite symptoms of a heart attack is another possible sink for bad dollars.

The nurse was relatively inexeprienced. These are things that happened to my wife and me on different occasions at different hospitals in just over a half century of life.

So, right away, we have to suspect that poverty is a major factor. We know that poverty is correlated with poor nutrition, poor education, higher rates of smoking, environmental discrimination, higher levels of violence, higher rates of alcohol abuse and the abuse of illegal drugs, etc.

Maybe poverty is associated with no insurance?

- EOM

Irresponsible poor creatures! Why did they even choose to be born poor in the first place? Right off they put themselves at a disadvantage and deserve substandard care and zero empathy!

...He wouldna made 'em poor.

Oh! The miracle of life! A tiny little embryo, one of God's children!

Oh! The miracle of life! A mid-term fetus, swimming happily in God's love!

Oh! The miracle of life! A child about to take it's first breath of God's air!

Miserable little welfare cheat.

You are a purveyor of mil-spec high-octane snark. I tip my hat to you.

[sic]

-EOM

at Joaqin's comment" with "amusement about the underlying issues" is your own conceit rather than my position - if you want to talk "straw man argumentation". :)

I'm not at all convinced, but, perhaps.

-t

in the position of being able to assess and report my own beliefs; "convincing" you that I'm truthfully reporting those beliefs ranks pretty low on my priority list.

Off the cuff I'd reckon it ranks somewhat lower in importance to me than perfectly aligning the pillows on my bed in the morning or making sure my sock drawer's tidy.

False modesty compels me to admit that's the jist of a Jules Pfeiffer cartoon from 75 or 80 FUs ago. By any sane moral reckoning, it's been in the public domain for quite awhile.

- EOM

Who was I replying to?

You showed your colors when here you said "I think we would agree that deep, structural changes are called for", but here you said "It is quite a leap to get from something like infant mortality rates to the conclusion that reform of the health care system is the cure."

Joaquin put the nail in when he said "Maybe poverty is associated with no insurance?"

BTW, the quote you'll deny you're looking for begins with "A foolish consistency" and ends with "adored by little statesmen and philosophers and divines." Poor Ralph, always being taken out of context.

Poverty correlates with lack of insurance or, more precisely, a ridiculously limited access to health care. (It also, according to one study (from RAND), correlates with better outcomes once medical care is invoked!).

That's *correlates*. Race correlates with poverty correlates with high infant mortality. Poverty correlates with lack of insurance. By transititivity, high infant mortality correlates with high infant mortality. *correlates*.

What causes high infant mortality? What's the most effective steps to take to alleviate or offset causes? Very different questions.

I understand you to be accusing me of logical inconsistency. In doing so, in that way, you are committing a logical incoherency based on a mathematical misunderstanding of statistics.

-t

I was a math major. Correlation is not transitive.

Now say something useful or STFU.

I was too (math/cs).

Correlation is not transitive in a very formal algebraic sense that doesn't have a lot of relevance here. It is probabilistically transitive in a way that applies as I very clearly used it here. At any rate, that probabilistic transitivity is what is at the heart of YOUR position, not mine. At best, you are yelling that my argument against your position isn't as good as your own argument against your own position.

STFU yourself.

-t

I have taken no position to argue for or against - merely some jokes and asides in this thread. I noted that you called for deep structural reform in one comment, then argued against it in another.

"By transititivity, high infant mortality correlates with high infant mortality."

Now that I've stopped laughing, I'll note that you meant either "race" or "poverty" in the subject of that sentence. Doesn't matter.

If I take you seriously and ignore the nonsense, you argue that fixing poverty may give more bang for the buck than changing our healthcare system. Do you actually believe that? (A simple yes or no will suffice).

"fixing poverty may give more bang for the buck...."

Roughly, yes.

-t

...account for 50% of the bankruptcies in this country (often despite being insured), might not the healthcare system be part of the problem?

From this article :

A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses (14). Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.

Doesn't fighting poverty mean fighting both problems?

If you read my various comments, I think you'll see that I'm very much in favor of, and predicting, and advocating for social policies that work on poverty and reforms to the medical system. I'm not sure what you're arguing against here.

$12K, btw, isn't enough an excuse for many people at all to successfully file for bankruptcy -- for a few, who are actually forced that far, it's a certain route to chapter 13 restructuring. While that $12K average was listed in 50% of filings -- what was its average percentage of overall debt?

-t

...anyone proposing changes, and you actually propose nothing yourself, I am forced to concede that you are, indeed, a troll.

I hope you had fun.

How is that I "argue against ... anyone proposing changes?"

I argue against the abuse of statistics. I argue against advocacy of single payer systems that lack logical support.

I've pointed out where the positive action seems to me to be happening: restructuring of the industry towards physician salaries instead of pay-per-service (following the VA model); adoption of electronic medical records but with appropriate consideration to privacy (following but also criticizing the VA model).

Is your goal here to do the hard work of developing a progressive agenda? Or is it to pimp in populist ways for a certain, emerging, party agenda? Do you care about health care more? or more about who gets elected? or simply that you always say "Tom is wrong, and trolling?" You seem like you're being reactionary, in this thread.

-t

Because people of color are more likely to be poor and people who are poor are less likely to have access to decent medical care. I'm just correlating some things here! The cure for this is equal access for all which will surely happen before the year 3653; which is when the Star Trek like automatic food synthesizers are invented. To create equal access before then, we might want to disconnect access from economic class by reforming health care. ... or we could decide that access to breathable air and water should be paid for like our current health services, in which case, there won't be a problem with poverty any more.

EOM

EOM

possibility. :D

And another.

At the time, universal health care (of the single payer variety) was largely seen as inevitable. Medicare parts A & B were just the competing Republican / Democratic plans. They avoided a fight by just passing them both. Then we had recessions, then we got Reagan who convinced white middle class America that social spending just went to putting diamond rear windows into cadillacs in the ghetto whereas God clearly wanted us to give money to rich white people.

Oh look, I found me a dollar. I know, I'll give to Pat Robertson! He's a rich man, he'll know what to do with it!

Overview of Universal Health Care Several modalities are included
#1 Single Payer,
#2 Hybrid and
#3 Private

I'll take door #1 thank you very much!

Free market system keeps the cost down! Excuse me...I'm rolling on the floor with laughter at such an absurd suggestion!